Establishment of the International Maritime Health Foundation: the next step in scientific publishing in maritime health.

The Bulletin of the Institute of Maritime and Tropical Medicine (IMTM) was published first time in 1948 as a preliminary publication. Since then it has developed and from 1999 it is known as International Maritime Health (IMH). Initially it was published by the Institute of Maritime and Tropical Medicine (IMTM) in Gdynia. From 2009 it was published by the Polish Society of Maritime, Tropical and Travel Medicine (PSMTTM) in cooperation with the International Maritime Health Association (IMHA) and the Norwegian Centre for Maritime Medicine (NCMM), later the Norwegian Centre for Maritime and Diving Medicine (NCMDM) at the Department of Occupational Medicine, Haukeland University Hospital, Bergen. After a couple of years of planning and discussions on how to take the journal forward, the International Maritime Health Foundation (IMHF) was established under Polish Law, 21st June 2018. This article discusses the process from the very beginning of the journal, until the establishment of the IMHF as well as the foundation's objectives and way forward.

The Functional Roles of the MDM2 Splice Variants P2-MDM2-10 and MDM2-∆5 in Breast Cancer Cells.

BACKGROUND: MDM2 is a negative regulator of p53 and is upregulated in numerous human cancers. While different MDM2 splice variants have been observed in both normal tissues and malignant cells, their functions are poorly understood. METHODS: We evaluated the effect of MDM2 splice variants by overexpression in MCF-7 cells and analyses of expression of downstream genes (qPCR and Western blot), subcellular localization (immunofluorescence), cell cycle assays (Nucleocounter3000), apoptosis analysis (Annexin V detection), and induction of senescence (ß-galactosidase analysis). RESULTS: In a screen for MDM2 splice variants in MCF-7 breast cancer cells, extended with data from healthy leukocytes, we found P2-MDM2-10 and MDM2-Δ5 to be the splice variants expressed at highest levels. Contrasting MDM2 full-length protein, we found normal tissue expression levels of P2-MDM2-10 and MDM2-Δ5 to be highest in individuals harboring the promoter SNP309TT genotype. While we detected no protein product coded for by MDM2-Δ5, the P2-MDM2-10 variant generated a protein markedly more stable than MDM2-FL. Both splice variants were significantly upregulated in stressed cells (P=4.3 × 10-4 and P=7.1 × 10-4, respectively). Notably, chemotherapy treatment and overexpression of P2-MDM2-10 or MDM2-Δ5 both lead to increased mRNA levels of the endogenous MDM2-FL (P=.039 and P=.070, respectively) but also the proapoptotic gene PUMA (P=.010 and P=.033, respectively), accompanied by induction of apoptosis and repression of senescence. CONCLUSION: We found P2-MDM2-10 and MDM2-Δ5 to have distinct biological functions in breast cancer cells. GENERAL SIGNIFICANCE: Alternative splicing may influence the oncogenic effects of the MDM2 gene.

Coagulation function of stored whole blood is preserved for 14 days in austere conditions: A ROTEM feasibility study during a Norwegian antipiracy mission and comparison to equal ratio reconstituted blood.

BACKGROUND: Formulation of a medical preparedness plan for treating severely bleeding casualties during naval deployment is a significant challenge because of territory covered during most missions. The aim of this study was to evaluate the concept of "walking blood bank" as a supportable plan for supplying safe blood and blood products. METHODS: In 2013, the Royal Norwegian Navy conducted antipiracy operations from a frigate, beginning in the Gulf of Aden and ending in the Indian Ocean. Crews were on 24-hour emergency alert in preparation for an enemy assault on the frigate. Under an approved command protocol, a "walking blood bank," using crew blood donations, was established for use on board and on missions conducted in rigid-hulled inflatable boats, during which freeze-dried plasma and leukoreduced, group O low anti-A/anti-B titer, cold-stored whole blood were stored in Golden Hour Boxes. Data demonstrating the ability to collect, store, and provide whole blood were collected to establish feasibility of implementing a whole blood-focused remote damage-control resuscitation program aboard a naval vessel. In addition, ROTEM data were collected to demonstrate feasibility of performing this analysis on a large naval vessel and to also measure hemostatic efficacy of cold-stored leukoreduced whole blood (CWB) stored during a period of 14 days. ROTEM data on CWB was compared with reconstituted whole blood. RESULTS: Drills simulating massive transfusion activation were conducted, in which 2 U of warm fresh whole blood with platelet sparing leukoreduction were produced in 40 minutes, followed by collection of two additional units at 15-minute increments. The ROTEM machine performed well during ship-rolling, as shown by the overlapping calculated and measured mechanical piston movements measured by the ROTEM device. Error messages were recorded in 4 (1.5%) of 267 tests. CWB yielded reproducible ROTEM results demonstrating preserved fibrinogen function and platelet function for at least 3.5 weeks and 2 weeks, respectively. The frequency of ROTEM tests were as follows: EXTEM (n = 88), INTEM (n = 85), FIBTEM (n = 82), and APTEM (n = 12). CWB results were grouped. Compared with Days 0 to 2, EXTEM maximum clot firmness was significantly reduced, beginning on Days 10 to 14; however, results through that date remained within reference ranges and were comparable with the EXTEM maximum clot firmness for the reconstituted whole blood samples containing Day 5 room temperature-stored platelets. CONCLUSION: A "walking blood bank" can provide a balanced transfusion product to support damage-control resuscitation/remote damage-control resuscitation aboard a frigate in the absence of conventional blood bank products. ROTEM analysis is feasible to monitor damage-control resuscitation and blood product quality. ROTEM analysis was possible in challenging operational conditions. LEVEL OF EVIDENCE: Therapeutic study, level V.

Mental readiness for maritime international operation: procedures developed by Norwegian navy.

Seafarer's mental health is vital for a well-functioning organisation. Neglecting mental health status on board could be extremely costly for both the crew affected as well as the company. The present article outlines an extensive programme implemented in the Royal Norwegian Navy for personnel deployed in international operations. The challenges involved in international operations bare similarities to onboard personnel in civilian maritime operations. The program utilised by the Royal Norwegian Navy is extensive and not immediately applicable to civilian maritime companies. However, elements of this program could be used with limited resources. Questionnaire based screening, before, during and at the end of a contract period could result in early detections of mental health problems and increased retaining of personnel. This should be done by health professionals. Early targeting of at risk personnel could prevent serious costs for the individual as well as the company.

Legionella pneumophila in Norwegian naval vessels.

BACKGROUND: Little is known about the occurrence of Legionella pneumophila in water supply systems on board ships. Our aim was to study the occurrence of L. pneumophila in the water supply system on board Norwegian naval vessels as the basis for framing preventive strategies against Legionella infection. MATERIAL AND METHOD: Water samples were collected from technical installations and from the water distribution network on board 41 vessels and from ten water filling (bunkering) stations, the sampling taking place in two rounds separated by a one-year interval. The samples were subjected to analysis, including serotyping and genotyping, with a view to identifying the presence of L. pneumophila and of free-living amoebae. RESULTS: L. pneumophila was found in 20 out of a total of 41 vessels in the first round of sampling, and live L. pneumophila serogroup 1 was isolated in seven of the 20 vessels. Free-living amoebae were found in the water supply system in most of the vessels, including all the vessels with L. pneumophila. The same genotype of L. pneumophila was identified in the water in bunkering stations and in the water on board the vessels. INTERPRETATION: L. pneumophila was not present in all the vessels, but all the vessels where the bacterium was found were also contaminated with free-living amoebae. We have demonstrated the probability of the fresh water from bunkering stations being the source of the contamination. In framing preventive strategies, importance should therefore be attached to identifying the source of contamination and the presence of free-living amoebae, as a premise for the establishment and growth of L. pneumophila in onboard water supply systems.

Cultural differences in emotional intelligence among top officers on board merchant ships.

The current research investigated cultural differences in emotional intelligence among top officers on board vessels of multicultural maritime companies. We found that Southeast Asian officers scored higher than European officers on the total Emotional Intelligence scale. When separating the EQ scale in its facets, higher scores for Asian officers were found on "Utilization of emotions", "Handling relationships", and on "Self-control". Another finding was that Chief officers/Second engineers scored higher than Masters/Chief Officers on "Self-control". Finally, we found a negative correlation between age and scores on the facet of "Self-control". These crosscultural differences may have implications for interpersonal relations and ship management.

MDM2 promoter SNP344T>A (rs1196333) status does not affect cancer risk.

The MDM2 proto-oncogene plays a key role in central cellular processes like growth control and apoptosis, and the gene locus is frequently amplified in sarcomas. Two polymorphisms located in the MDM2 promoter P2 have been shown to affect cancer risk. One of these polymorphisms (SNP309T>G; rs2279744) facilitates Sp1 transcription factor binding to the promoter and is associated with increased cancer risk. In contrast, SNP285G>C (rs117039649), located 24 bp upstream of rs2279744, and in complete linkage disequilibrium with the SNP309G allele, reduces Sp1 recruitment and lowers cancer risk. Thus, fine tuning of MDM2 expression has proven to be of significant importance with respect to tumorigenesis. We assessed the potential functional effects of a third MDM2 promoter P2 polymorphism (SNP344T>A; rs1196333) located on the SNP309T allele. While in silico analyses indicated SNP344A to modulate TFAP2A, SPIB and AP1 transcription factor binding, we found no effect of SNP344 status on MDM2 expression levels. Assessing the frequency of SNP344A in healthy Caucasians (n = 2,954) and patients suffering from ovarian (n = 1,927), breast (n = 1,271), endometrial (n = 895) or prostatic cancer (n = 641), we detected no significant difference in the distribution of this polymorphism between any of these cancer forms and healthy controls (6.1% in healthy controls, and 4.9%, 5.0%, 5.4% and 7.2% in the cancer groups, respectively). In conclusion, our findings provide no evidence indicating that SNP344A may affect MDM2 transcription or cancer risk.

Cause-specific mortality and cancer incidence among 28,300 Royal Norwegian Navy servicemen followed for more than 50 years.

OBJECTIVES: The aim of this study was to examine mortality and cancer incidence in a cohort of 28,300 military servicemen known, from personnel files, to have served in the Royal Norwegian Navy during 1950-2004. METHODS: The cohort was followed from 1951-2007 for mortality and from 1953-2008 for cancer. Standardized mortality ratios (SMR) and incidence ratios (SIR) for cancer were calculated from national rates. Internal comparisons [rate ratios (RR)] were made using Poisson regression. RESULTS: Mortality for all Navy personnel was lower than expected for all causes combined (SMR 0.84) and for most disease groups and violent causes, but not for cancer mortality (SMR 1.02). Vessel crews had consistently higher SMR than land-based personnel, still with rates lower than - or close to - national ones. The relative risk between the two subgroups was in the same direction for mortality from alcohol abuse and non-malignant alcohol-related diseases (RR 1.56) and for the incidence of alcohol-related cancers (RR 1.58) and lung cancer (RR 1.65). An overall small excess in the incidence of all cancers combined for the entire cohort (SIR 1.06) was caused by prostate cancer, malignant melanoma, and non-melanoma skin cancer. An excess of bladder cancer was observed among submariners (SIR 1.53). CONCLUSION: The low all-cause mortality was in line with a "healthy soldier effect". Navy personnel had a lower-than-expected mortality from accidents and suicide. Alcohol-related diseases were more frequent among vessel crews than among land-based personnel, but largely comparable to the rates among all Norwegian men.

A study of side-effects of Pandemrix® influenza (H1N1) vaccine on board a Norwegian naval vessel.

BACKGROUND: The frigate His Norwegian Majesty's ship (HNoMS) Fridtjof Nansen was participating in operations in the Gulf of Aden in support of the EU mission tasked with protecting vessels from the threat of piracy. The crew was therefore prioritized and given the first batch of Influenza A (H1N1) vaccine (Pandemrix(®)). OBJECTIVES: To investigate the type, frequency, and intensity of side effects after whole-crew vaccination with Pandemrix vaccine in healthy subjects in a controlled environment. MATERIAL AND METHODS: A hundred and thirty-three members of the crew were vaccinated, and then they participated in the study. The side effects of the vaccination were evaluated through a survey. RESULTS: Seventy-five per cent of the vaccinated sailors reported adverse reactions to the vaccine, with 9% not being able to perform their daily duties for one day. Muscle pain, headaches, malaise, and fatigue were the most frequent symptoms reported. CONCLUSIONS: The vaccination program using Pandemrix H1N1 vaccine resulted in a high rate of side effects, which were generally mild and resolved within a few days. No serious lasting side effects of the vaccination were reported or registered. The adverse effects of the vaccination did not affect the operational capacity of the vessel.

Asbestos-related cancers among 28,300 military servicemen in the Royal Norwegian Navy.

INTRODUCTION: This study focus on the incidence of asbestos-related cancers among 28,300 officers and enlisted servicemen in the Royal Norwegian Navy. Until 1987, asbestos aboard the vessels potentially caused exposure to 11,500 crew members. METHODS: Standardized incidence ratios (SIR) were calculated for malignant mesothelioma, lung cancer, and laryngeal, pharyngeal, stomach, and colorectal cancers according to service aboard between 1950 and 1987 and in other Navy personnel. RESULTS: Increased risk of mesothelioma was seen among engine room crews, with SIRs of 6.23 (95% CI = 2.51-12.8) and 6.49 (95% CI = 2.11-15.1) for personnel who served less than 2 years and those with longer service, respectively. Lung cancer was nearly 20% higher than expected among both engine crews and non-engine crews. An excess of colorectal cancer bordering on statistical significance was seen among non-engine crews (SIR = 1.14; 95% CI = 0.98-1.32). Land-based personnel and personnel who served aboard after 1987 had lower lung cancer incidence than expected (SIR = 0.77; 95% CI = 0.64-0.92). No elevated risk of laryngeal, pharyngeal, or stomach cancers was seen. CONCLUSION: The overall increase (65%) in mesotheliomas among military Navy servicemen was confined to marine engine crews only. The mesothelioma incidence can be taken as an indicator of the presence or absence of asbestos exposure, but it offered no consistent explanation to the variation in incidence of other asbestos-related cancers.

[Tuberculosis in the Royal Norwegian Navy at the time of the Second World War]. / Tuberkulose i Den Kongelige Norske Marine under krigen.

Tuberculosis became a great problem in the Royal Norwegian Navy during the first years of the Second World War (when it operated in allied services mainly from the UK); with the highest incidence (9.6 per 1 000) during the first half of 1943. Main reasons were insufficient medical examination of recruits, crowded living conditions on board (favoured the contagion) and the physical and psychological pressure during sea operations, which may have reduced the immune defence. Prophylactic measures in terms of tuberculin testing of all personnel, chest X-rays of the positives, vaccination of the negatives, environment investigation when disease was discovered, and isolation of those infected, gave control from the second half of 1943 and onwards. The article also mentions treatment, repatriation and the incidence of tuberculosis in the Norwegian Navy before and after the war as well as in the Royal Canadian Naval Services (where the incidence was low) during the war. Today, the tuberculosis situation in Norway is so favourable that routine chest X-ray of the recruits is no longer performed in the armed forces.

[An Enemy of the People--about Dr Harald Engelsen and work-related lead poisoning in Horten]. / Enda en folkefiende--om Harald Engelsen og blyforgiftningssaken i Horten.

Little attention was paid to lead poisoning in Norway before 1930. In 1931-33, however, Dr Harald Engelsen, a naval surgeon, reported to the National Insurance Administration more than 40 cases among shipyard workers. The first worker in which he diagnosed lead poisoning had consulted other doctors, but only got a symptomatic diagnosis. Dr Engelsen was then consulted by several others with similar symptoms. At the outset his diagnosis was doubted and a considerable disagreement ensued with colleagues and yard representatives; he was compared with Dr Stockmann in Henrik Ibsen's play An Enemy of the People. The controversy escalated. A commission appointed by the government to examine the matter concluded that there had been cases of lead poisoning in the shipyard, that mandatory requirements had not been strictly complied with, and that monitoring of working conditions had been fragmentary. Most of the workers were granted compensation and pensions. For a publication on lead poisoning, Dr Engelsen was awarded the University of Oslo's gold medal, and for his work for improving seamen's health and welfare he was awarded the St. Olav Order. In 1938 he was appointed head of medical services in the Royal Norwegian Navy.